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Auld BC, Abell B, Venugopal PS, McPhail S. Geographical challenges and inequity of healthcare access for high-risk paediatric heart disease. Int J Equity Health 2023; 22:229. [PMID: 37915092 PMCID: PMC10619221 DOI: 10.1186/s12939-023-02040-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Geographical context is an important consideration for health system design to promote equality in access to care for patients with childhood heart disease (CHD), particularly those living in regional, rural, and remote areas. To help inform future policy and practice recommendations, this study aimed to (i) describe the geographic distribution of high-risk CHD patients accessing an Australian state-wide specialist service and (ii) estimate travel time for accessing healthcare via general practitioners (primary), nearest paediatric centre (secondary) and specialist paediatric cardiac centre (tertiary). METHODS Participants included a cohort of children (0-18 year) who accessed state-wide specialist CHD services over a 3-year period (2019-2021) in Queensland, Australia. Locations for patient residence, general practitioner, closest paediatric centre and tertiary cardiac centre were mapped using geographical information system (GIS) software (ArcGIS Online). Travel distance and times were estimated using a Google Maps Application Programming Interface (API). RESULTS 1019 patients (median age 3.8 years) had cardiac intervention and were included in the sample. Of this cohort, 30.2% lived outside the heavily urbanised South East Queensland (SEQ) area where the tertiary centre is located. These patients travel substantially further and longer to access tertiary level care (but not secondary or primary level care) compared to those in SEQ. Median distance for patients residing outside SEQ to access tertiary care was 953 km with a travel time of 10 h 43 min. This compares to 5.5 km to the general practitioner and 20.6 km to a paediatric service (8.9 and 54 min respectively). CONCLUSION This geographical mapping of CHD services has demonstrated a key challenge inherent in providing specialist cardiac care to children in a large state-based healthcare system. A significant proportion of high-risk patients live large distances from tertiary level care. The greater accessibility of primary care services highlights the importance of supporting primary care physicians outside metropolitan areas to acquire or build the ability and capacity to care for children with CHD. Strengthening local primary and secondary services not only has the potential to improve the outcomes of high-risk patients, but also to reduce costs and burden associated with potentially avoidable travel from regional, rural, or remote areas to access specialist CHD services.
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Affiliation(s)
- Benjamin C Auld
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, 501 Stanley St, South Brisbane, QLD, 4101, Australia.
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Qld, 4059, Australia.
| | - Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Qld, 4059, Australia
| | - Prem S Venugopal
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, 501 Stanley St, South Brisbane, QLD, 4101, Australia
| | - Steven McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Qld, 4059, Australia
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Psychological functioning in paediatric patients with single ventricle heart disease: a systematic review. Cardiol Young 2022; 32:173-184. [PMID: 35045915 DOI: 10.1017/s1047951122000063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients with single ventricle heart disease are living into adulthood due to medical and surgical advancements but have significant physical comorbidities and an increased risk for psychological comorbidities compared to healthy subjects or those with other CHD diagnoses. This study aimed to systematically review psychological functioning in paediatric single ventricle heart disease. METHODS Literature was searched using PubMed, Embase, PsycInfo, CINAHL Complete and Scopus. Peer-reviewed articles that included patients ages 0-25 years with single ventricle heart disease, and quantitative measures of psychological outcomes were included. Meta-analysis using a fixed-effect model was conducted for internalising and externalising t-scores, utilised by the Achenbach Child Behavior Checklist. RESULTS Twenty-nine records met the criteria for inclusion. 13/24 studies demonstrated increased risk for internalising disorders, such as anxiety/depression; 16/22 studies demonstrated risk for externalising disorders, such as attention or behavioural problems. Meta-analysis of four studies revealed that paediatric single ventricle heart disease patients had no significant difference in internalising and externalising t-scores compared to normative values. CONCLUSIONS The current review demonstrates the need for further studies to better understand psychological functioning in patients with single ventricle heart disease, with a majority of studies showing increased risk for psychological problems despite no difference seen in a small meta-analysis. This summary of the literature underscores the need for regular psychological screening, earlier intervention and integrated mental health therapies in paediatric single ventricle heart disease.
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Monteiro SA, Serrano F, Tsang R, Smith Hollier E, Guffey D, Noll L, Voigt RG, Ghanayem N, Shekerdemian L. Ancillary referral patterns in infants after initial assessment in a cardiac developmental outcomes clinic. CONGENIT HEART DIS 2019; 14:797-802. [DOI: 10.1111/chd.12789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/04/2019] [Accepted: 04/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Faridis Serrano
- Department of Pediatrics Baylor College of Medicine Houston Texas
| | - Rocky Tsang
- Department of Pediatrics Baylor College of Medicine Houston Texas
| | | | - Danielle Guffey
- Dan L Duncan Institute for Clinical and Translational Research Baylor College of Medicine Houston Texas
| | - Lisa Noll
- Department of Pediatrics Baylor College of Medicine Houston Texas
| | - Robert G. Voigt
- Department of Pediatrics Baylor College of Medicine Houston Texas
| | - Nancy Ghanayem
- Department of Pediatrics Baylor College of Medicine Houston Texas
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Martinez-Rios C, McKinney JR, Al-Aswad N, K Shergill A, Louffat AF, Sung L, Thomas KE, Schuh S, Tomlinson G, Moineddin R, Doria AS. Parental preferences on diagnostic imaging tests for paediatric appendicitis. Paediatr Child Health 2018; 24:234-239. [PMID: 31239812 DOI: 10.1093/pch/pxy154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/27/2018] [Indexed: 02/06/2023] Open
Abstract
Objectives To determine parental preferences for diagnostic imaging tests (DITs) for paediatric appendicitis, to rank the attributes impacting the DIT selection and to identify DIT attributes that would cause parents to switch their DIT. Methods Parents of children who had an abdominal ultrasound (US) for right lower quadrant pain were interviewed. Two DITs were compared at a time, parents were asked to indicate their preferred test and to rank its attributes according to the impact each attribute had on their selection. The strength of their preference for the chosen DIT was measured by systematically adjusting attributes of the chosen DIT until the parent changed their choice. Results Fifty parents were interviewed. For US versus CT, more parents preferred US (68%, P=0.02) with higher importance ranks for cancer risk (P<0.0001), test accuracy (P=0.04), pain during test (P=0.3), and scan length (P<0.0001); and lower ranks for sedation (P=0.02), intravenous (IV) (P<0.02), and oral contrast (P=0.06). For US versus MRI, parents preferred MRI (78%, P<0.0001) with higher importance ranks for accuracy (P=0.2), pain during test (P=0.06), and scan length (P=0.06); and lower for noise (P<0.0001), claustrophobia (P<0.0001), use of IV contrast (P=0.06), and sedation (P=0.2). Conclusion US and MRI were the DIT preferred by parents for the investigation of acute paediatric appendicitis.
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Affiliation(s)
- Claudia Martinez-Rios
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Imaging, CHEO, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer R McKinney
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.,Graduate Entry Medical School, The University of Limerick, Limerick, Ireland
| | - Nadine Al-Aswad
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arvind K Shergill
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Ada F Louffat
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lillian Sung
- Department of Pediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Karen E Thomas
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Suzanne Schuh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - George Tomlinson
- Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Bishop CF, Small N, Parslow R, Kelly B. Healthcare use for children with complex needs: using routine health data linked to a multiethnic, ongoing birth cohort. BMJ Open 2018. [PMID: 29525769 PMCID: PMC5855244 DOI: 10.1136/bmjopen-2017-018419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Congenital anomaly (CA) are a leading cause of disease, death and disability for children throughout the world. Many have complex and varying healthcare needs which are not well understood. Our aim was to analyse the healthcare needs of children with CA and examine how that healthcare is delivered. DESIGN Secondary analysis of observational data from the Born in Bradford study, a large prospective birth cohort, linked to primary care data and hospital episode statistics. Negative binomial regression with 95% CIs was performed to predict healthcare use. The authors conducted a subanalysis on referrals to specialists using paper medical records for a sample of 400 children. SETTING Primary, secondary and tertiary healthcare services in a large city in the north of England. PARTICIPANTS All children recruited to the birth cohort between March 2007 and December 2011. A total of 706 children with CA and 10 768 without CA were included in the analyses. PRIMARY AND SECONDARY OUTCOME MEASURES Healthcare use for children with and without CA aged 0 to <5 years was the primary outcome measure after adjustment for confounders. RESULTS Primary care consultations, use of hospital services and referrals to specialists were higher for children with CA than those without. Children in economically deprived neighbourhoods were more likely to be admitted to hospital than consult primary care. Children with CA had a higher use of hospital services (β 1.48, 95% CI 1.36 to 1.59) than primary care consultations (β 0.24, 95% CI 1.18 to 0.30). Children with higher educated mothers were less likely to consult primary care and hospital services. CONCLUSIONS Hospital services are most in demand for children with CA, but also for children who were economically deprived whether they had a CA or not. The complex nature of CA in children requires multidisciplinary management and strengthened coordination between primary and secondary care.
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Affiliation(s)
| | - Neil Small
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Roger Parslow
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - Brian Kelly
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
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Lu JC, Lowery R, Yu S, Ghadimi Mahani M, Agarwal PP, Dorfman AL. Predictors of missed appointments in patients referred for congenital or pediatric cardiac magnetic resonance. Pediatr Radiol 2017; 47:911-916. [PMID: 28432402 DOI: 10.1007/s00247-017-3851-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/19/2017] [Accepted: 03/27/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital cardiac magnetic resonance is a limited resource because of scanner and physician availability. Missed appointments decrease scheduling efficiency, have financial implications and represent missed care opportunities. OBJECTIVE To characterize the rate of missed appointments and identify modifiable predictors. MATERIALS AND METHODS This single-center retrospective study included all patients with outpatient congenital or pediatric cardiac MR appointments from Jan. 1, 2014, through Dec. 31, 2015. We identified missed appointments (no-shows or same-day cancellations) from the electronic medical record. We obtained demographic and clinical factors from the medical record and assessed socioeconomic factors by U.S. Census block data by patient ZIP code. Statistically significant variables (P<0.05) were included into a multivariable analysis. RESULTS Of 795 outpatients (median age 18.5 years, interquartile range 13.4-27.1 years) referred for congenital cardiac MR, a total of 91 patients (11.4%) missed appointments; 28 (3.5%) missed multiple appointments. Reason for missed appointment could be identified in only 38 patients (42%), but of these, 28 (74%) were preventable or could have been identified prior to the appointment. In multivariable analysis, independent predictors of missed appointments were referral by a non-cardiologist (adjusted odds ratio [AOR] 5.8, P=0.0002), referral for research (AOR 3.6, P=0.01), having public insurance (AOR 2.1, P=0.004), and having scheduled cardiac MR from November to April (AOR 1.8, P=0.01). CONCLUSION Demographic factors can identify patients at higher risk for missing appointments. These data may inform initiatives to limit missed appointments, such as targeted education of referring providers and patients. Further data are needed to evaluate the efficacy of potential interventions.
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Affiliation(s)
- Jimmy C Lu
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan Health System, University of Michigan Congenital Heart Center, C. S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI, 48109-4204, USA.
- Department of Radiology, University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children's Hospital, Ann Arbor, MI, USA.
| | - Ray Lowery
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan Health System, University of Michigan Congenital Heart Center, C. S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI, 48109-4204, USA
| | - Sunkyung Yu
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan Health System, University of Michigan Congenital Heart Center, C. S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI, 48109-4204, USA
| | - Maryam Ghadimi Mahani
- Department of Radiology, University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Prachi P Agarwal
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Adam L Dorfman
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan Health System, University of Michigan Congenital Heart Center, C. S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI, 48109-4204, USA
- Department of Radiology, University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children's Hospital, Ann Arbor, MI, USA
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Determinants of successful medical education of caregivers of children with congenital heart diseases. J Saudi Heart Assoc 2017; 30:28-39. [PMID: 29296062 PMCID: PMC5744025 DOI: 10.1016/j.jsha.2017.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/19/2016] [Accepted: 03/09/2017] [Indexed: 12/28/2022] Open
Abstract
Objective To assess the implementation and efficiency of medical education among the caregivers of children with congenital heart disease (CHD) and to investigate its success factors. Material and method A cross-sectional study was conducted from February 2014 to March 2014 in a tertiary healthcare center. Study included 120 caregivers of children with CHD visiting the Paediatric Cardiology Clinic that included 93% mothers, aged 31.72 ± 6.67 years, 38.3% Saudi citizens and 45.0% had a high educational level. Caregivers were interviewed through a semi-structured questionnaire that included socio-demographic data of participants and demographic and clinical data of patients; awareness about the diagnosis and self-assessed understanding of thedisease; disease dimensions explained, educational material used andefficacy of whole medical education received in alleviating caregivers' anxiety. Results Of children who had CHD, around 42.5% were males aged 5.65 ± 3.99 years and 37.3% had ventral septal defect, 14.4% had atrial septal defectand 19.5% had a complex CHD. Study results showed that 83.3% of caregivers were aware of the correct diagnosis and 64.2% had good understanding of the nature and effect of the disease. Frequently explained disease dimensions were impact on child's growth (65.8%), complications (57.5%), and outcomes (55.0%). Least frequently explained dimensions were those related to infective endocarditis (IEC) including risk factors (15.8%), prophylaxis (17.5%), complications (19.2%) and symptoms (22.5%). The whole medical education received was efficient to enable good understanding of the disease and alleviate anxiety in 70.8% and 62.5% of the cases, respectively. Time dedicated to educate, use of illustrating educational materials, explaining various disease dimensions (aetiology, complications, prognosis, long-term management, etc.) and the number of dimensions explained were all significant predictors for both good understanding of the child's disease and anxiety relief among caregivers.
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